The use of non-invasive ventilation in very old patients with hypercapnic acute respiratory failure because of COPD exacerbation

Nicolini, Antonello; Santo, Mario; Ferrera, Lorenzo; Ferrari-Bravo, Maura; Barlascini, Cornelius; Perazzo, Alessandro

doi:10.1111/ijcp.12484

Cited by 26 publications

(17 citation statements)

References 25 publications

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“…The review included 21 studies, eight of which comprised unselected medical admissions [ 4 , 10 – 12 , 26 – 29 ] and 13 which considered specific medical conditions [ 30 – 42 ]. All were cohort studies; 11 prospective and 10 retrospective.…”

Section: Resultsmentioning

confidence: 99%

Reduced level of arousal and increased mortality in adult acute medical admissions: a systematic review and meta-analysis

et al. 2017

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BackgroundReduced level of arousal is commonly observed in medical admissions and may predict in-hospital mortality. Delirium and reduced level of arousal are closely related. We systematically reviewed and conducted a meta-analysis of studies in adult acute medical patients of the relationship between reduced level of arousal on admission and in-hospital mortality.MethodsWe conducted a systematic review (PROSPERO: CRD42016022048), searching MEDLINE and EMBASE. We included studies of adult patients admitted with acute medical illness with level of arousal assessed on admission and mortality rates reported. We performed meta-analysis using a random effects model.ResultsFrom 23,941 studies we included 21 with 14 included in the meta-analysis. Mean age range was 33.4 - 83.8 years. Studies considered unselected general medical admissions (8 studies, n=13,039) or specific medical conditions (13 studies, n=38,882). Methods of evaluating level of arousal varied. The prevalence of reduced level of arousal was 3.1%-76.9% (median 13.5%). Mortality rates were 1.7%-58% (median 15.9%). Reduced level of arousal was associated with higher in-hospital mortality (pooled OR 5.71; 95% CI 4.21-7.74; low quality evidence: high risk of bias, clinical heterogeneity and possible publication bias).ConclusionsReduced level of arousal on hospital admission may be a strong predictor of in-hospital mortality. Most evidence was of low quality. Reduced level of arousal is highly specific to delirium, better formal detection of hypoactive delirium and implementation of care pathways may improve outcomes. Future studies to assess the impact of interventions on in-hospital mortality should use validated assessments of both level of arousal and delirium.Electronic supplementary materialThe online version of this article (10.1186/s12877-017-0661-7) contains supplementary material, which is available to authorized users.

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Section: Resultsmentioning

confidence: 99%

Reduced level of arousal and increased mortality in adult acute medical admissions: a systematic review and meta-analysis

et al. 2017

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“…The review included 21 studies, eight of which comprised unselected medical admissions [4,[10][11][12][26][27][28][29] and 13 which considered specific medical conditions [30][31][32][33][34][35][36][37][38][39][40][41][42]. All were cohort studies; 11 prospective and 10 retrospective.…”

Section: Study Characteristicsmentioning

confidence: 99%

57reduced Level of Arousal and Increased Mortality in Adult Acute Medical Admissions: A Systematic Review and Meta-Analysis

2018

Age and Ageing

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Background: Reduced level of arousal is commonly observed in medical admissions and may predict in-hospital mortality. Delirium and reduced level of arousal are closely related. We systematically reviewed and conducted a meta-analysis of studies in adult acute medical patients of the relationship between reduced level of arousal on admission and in-hospital mortality. Methods: We conducted a systematic review (PROSPERO: CRD42016022048), searching MEDLINE and EMBASE. We included studies of adult patients admitted with acute medical illness with level of arousal assessed on admission and mortality rates reported. We performed meta-analysis using a random effects model. Results: From 23,941 studies we included 21 with 14 included in the meta-analysis. Mean age range was 33.4 -83.8 years. Studies considered unselected general medical admissions (8 studies, n=13,039) or specific medical conditions (13 studies, n=38,882). Methods of evaluating level of arousal varied. The prevalence of reduced level of arousal was 3.1%-76.9% (median 13.5%). Mortality rates were 1.7%-58% (median 15.9%). Reduced level of arousal was associated with higher in-hospital mortality (pooled OR 5.71; 95% CI 4.21-7.74; low quality evidence: high risk of bias, clinical heterogeneity and possible publication bias). Conclusions: Reduced level of arousal on hospital admission may be a strong predictor of in-hospital mortality. Most evidence was of low quality. Reduced level of arousal is highly specific to delirium, better formal detection of hypoactive delirium and implementation of care pathways may improve outcomes. Future studies to assess the impact of interventions on in-hospital mortality should use validated assessments of both level of arousal and delirium.

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“…Nicolini et al. evaluated the effectiveness of NIV in a cohort of very old patients (over 75 years old) hospitalized in respiratory high‐dependency care units and 6 month after discharge compared with a group of patients (under 75 years) admitted for the same problems . They had a high rate of NIV success, which was inversely correlated with the severity of baseline functional parameters (comorbidities, level of consciousness and arterial blood gases improvement after 2‐h NIV) .…”

Section: Acute‐on‐chronic Respiratory Failurementioning

confidence: 99%

“…Nicolini et al . showed that in the younger group, ICU survival was also very low (1/10–10%) . The ICU mortality was similar in the two groups.…”

Section: Acute‐on‐chronic Respiratory Failurementioning

confidence: 99%

Non‐invasive mechanical ventilation in elderly patients: A narrative review

Piroddi¹,

Barlascini²,

Esquinas

et al. 2016

Geriatrics Gerontology Int

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The treatment of acute respiratory failure with non-invasive ventilation (NIV) as a first-line therapy is increasingly common in intensive care units. The reduced invasiveness of NIV leads to better outcomes than endotracheal intubation in carefully selected groups of patients. Furthermore, the use of NIV as a palliative treatment for respiratory failure and dyspnea has become increasingly common. NIV also has an impact on the use of "do not intubate" orders. In the present narrative review, we explore the use and outcome of NIV in elderly patients. To accomplish this, we reviewed the most recent available medical literature. Geriatr Gerontol Int 2017; 17: 689-696.

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The use of non-invasive ventilation in very old patients with hypercapnic acute respiratory failure because of COPD exacerbation

Abstract: The use of NIV in very old patients was effective in many cases. Endotracheal intubation after NIV failure was not efficacious in either group.

Cited by 26 publications

References 25 publications

Reduced level of arousal and increased mortality in adult acute medical admissions: a systematic review and meta-analysis

Reduced level of arousal and increased mortality in adult acute medical admissions: a systematic review and meta-analysis

57reduced Level of Arousal and Increased Mortality in Adult Acute Medical Admissions: A Systematic Review and Meta-Analysis

Non‐invasive mechanical ventilation in elderly patients: A narrative review

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